the devil made her do it: understanding suicide, demonic
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The Devil Made Her Do it: Understanding Suicide, Demonic The Devil Made Her Do it: Understanding Suicide, Demonic
Discourse, and the Social Construction of 'Health' in Yucatan, Discourse, and the Social Construction of 'Health' in Yucatan,
Mexico Mexico
Beatriz M. Reyes-Foster University of Central Florida, [email protected]
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Original Citation Original Citation Reyes-Foster, Beatriz. 2013. The Devil Made Her Do it: Understanding Suicide, Demonic Discourse, and the Social Construction of 'Health' in Yucatan, Mexico. Journal of Religion and Violence 1(3): 363-381.
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The Devil Made Her Do it: Understanding Suicide, Demonic Discourse, and the Social
Construction of 'Health' in Yucatan, Mexico
Beatriz M. Reyes-Foster, PhD
University of Central Florida
Abstract
In the state of Yucatan, Mexico, the suicide rate more than doubles the Mexican national
average. This article uses ethnographic data to argue that 1) local understandings of
suicide in Yucatán reflect a logic of health among Yucatec Maya people hinging on the
belief that spiritual, bodily, and spatial balance must be maintained in order to prevent
“illness,” understood as bodily and spiritual suffering; and 2) that Yucatec Maya users of
Mexico’s public health system readily adapt the biomedical model to existing paradigms
that comingle spiritual, mental, and bodily health due in great part to the inherent
contradictions in both systems that simultaneously attribute responsibility for suicide and
take it away. This apparent contradiction is thus a sympathetic template on which
biomedical discourse and its imperfect application can map itself.
Keywords: suicide, demonic discourse, discourses of health, religion and biomedicine.
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Introduction1
On the evening of March 6, 2008, Ana2, a sixteen-year-old girl from Xulab, a
village in the eastern part of the state of Yucatan, Mexico, played basketball with her
girlfriends in the village square. She went home, got a drink from the family’s
refrigerator, and vanished into the bathroom. An hour later, her father discovered her
lifeless body hanging from the shower head. Two months later, on April 26, the body of
Ana’s seventeen-year-old best friend, María, was discovered sitting in a cross-legged
position in her bedroom, a hammock tightly wound around her neck.
These two deaths shook the small community to its core. Xulab, with a population
of less than 400 people, usually saw one or two deaths in a given year. The deaths of Ana
and María came as a devastating shock. Lidia, a community health technician, is trained
by the state public health administration to administer over-the-counter medication, first
aid, and address non-emergency health concerns. When the deaths took place, it was
Lidia’s responsibility to contact the physician in the nearest health clinic, located in a
community a twenty minute car ride down a dirt road.
Soon after Ana’s death, Lidia began to experience sudden anxiety. She startled
easily, and became very afraid of being home alone or of sleeping in her hammock. She
began to think obsessively about suicide. Her symptoms worsened after Maria’s death.
L: As for me, when it had just happened, I was afraid of laying down
in my hammock. God forbid the evil might make me do something like
that. I was afraid for myself.
BRF: So, the evil leads you to do it?
L: Yes
BRF: How? How does evil lead people to commit suicide?
L: It was like I no longer enjoyed listening to music or hearing people
talking. I felt very anxious, like I wanted to get out, to cry, to
scream, I don’t know. Go. I don’t even know where, I just knew I
wanted to go somewhere else. I felt like I couldn’t go on anymore.
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I felt like I was going crazy... I wondered, what did they feel?
When they hung themselves. I thought about it so much and I got
scared of doing the same thing. But with the help of the
psychologist and my prayers, thank God, I feel that I am becoming
calm again.
One could say that following Ana’s and subsequently Maria’s suicides, Lidia
began exhibiting textbook symptoms of clinical depression and post-traumatic stress
disorder or PTSD (American Psychiatric 2000). In a classical psychological narrative,
Lidia’s symptoms, appearing shortly after these traumatic events, would evidence a
causal relationship between the suicides (the trauma) and the symptoms (the depression
and PTSD). In fact, Lidia did seek professional psychological help, took medication, and,
eventually, her symptoms began to improve. On the surface, the globalization of
biomedicine and its discourse couldn’t be clearer: Lidia, both through her particular
symptomatology and by seeking help and complying with treatment despite serious
obstacles such as basic transportation between Xulab and the nearest town, is displaying
the sensibilities of a modern subject engaging in self-care (Foucault 1978). However,
Lidia did not see her symptoms as the result of trauma. She did not consider herself to be
suffering from trauma nor from any kind of mental illness. Instead, Lidia identified her
symptoms as a demonic strategy to lure her into suicide, though she also recognized that
treatment, combined with prayer, were an effective tactic of resistance. As such, Lidia’s
discourse is a fascinating example of yucatecan beliefs about spirituality and the etiology
of suicide.
Without a doubt, present-day yucatecan attitudes and beliefs about suicide contain
great ambivalence. Suicide is, on the one hand, completely nonagentive: the suicida is a
victim of a demonic power over which he or she has no control. On the other hand,
Catholicism and newer protestant theologies prohibit suicide. Personal responsibility is at
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once attributed to and taken away from the suicida. These views inform not only the
ways in which people affected by suicide process the suicide of others, but, as extensive
work with survivors of highly lethal suicide attempts shows, the motivations of people
who attempt suicide as well.
In this article, I argue that 1) local understandings of suicide in Yucatán reflect a
logic of health among Yucatec Maya people hinging on the belief that spiritual, bodily,
and spatial balance must be maintained in order to prevent “illness,” understood as bodily
and spiritual suffering; and 2) that Yucatec Maya users of Mexico’s public health system
readily adapt the biomedical model to existing paradigms that comingle spiritual, mental,
and bodily health due in great part to inherent contradictions in both systems that
simultaneously attribute responsibility and take it away. Discourse about suicide in
Yucatán contains an apparent contradiction informed by an unbounded personhood that
results in profound social ambivalence regarding the spiritual causes, and consequences,
of voluntary death. This apparent contradiction is thus a sympathetic template on which
biomedical discourse and its imperfect application can map itself.
Suicide in Yucatan reflects a local etiology of health that is simultaneously
spiritual and physical. This initial separation of the physical from the spiritual, however,
should be understood as a false Cartesian separation of body and soul. Within the large
body of work considering ritual from an anthropological perspective (cf. Asad, 1993;
Bell, 1992; Boremanse, 1993; Chao, 1999; Csordas, 1997; Hanks, 1984; Huntingon &
Metcalf, 1979), the work of Talal Asad (1993, 2003) has drawn critical connections
between ritual, disposition, and the body. Building on Mauss’ (1973) original concept of
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habitus, Asad argues that bodily ritual has a profound effect on disposition, thus drawing
attention to the centrality of the body in religious practice.
Religious practice is embedded in everyday in communities throughout
Yucatan: all homes have altars, usually in shared communal spaces. Rosarios and
Novenas, the gathering of groups of people in the community for rosary and novena
prayer, is a central part of social life. In any given community, people gather for rosary
prayers at least once, usually more, times a week. Maya communities have vibrant
religious lives. Protestant Mayas, who generally practice charismatic forms of Christian
fundamentalism, also engage in frequent bodily religious practice. Whether religion as
physical engagement predates Catholicism or not, the connection drawn by subjects on
the ground between physical and spiritual health falls within local logic and is further
strengthened by everyday ritual practice.
The research that forms the basis of this study was conducted throughout the year
2008 in the Mexican state of Yucatán. Research for this study was based on six months of
ethnographic in the area around and within the city of Valladolid (pop. 70,000) as well as
six months of institutional ethnography and in-depth interviews in the city of Merida
(pop. 1,000,000). Because my research was focused on users of Mexico’s government-
run public health system, my research subjects were primarily poor and of Yucatec Maya
descent. Research methods included participant observation within and outside clinical
settings, structured and unstructured interviews with users of mental health services
provided by the Mexican government, and archival research.
Background: Suicide in Yucatán Past and Present
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Although suicide captured the attention of sociologists and anthropologists
(Durkheim 1951, Bohannan 1960, Giddens 1964), anthropological literature on suicide is
relatively scant. Recent years, however, have seen a resurgence in the topic, particularly
in the form of a special issue devoted to the topic in Culture, Medicine, and Psychiatry
(2012) and a Max Planck Institute Workshop situated around the role of suicide and
agency. As a subject of study, suicide’s potential lies in its simultaneous universality and
particularity: although self-inflicted death happens in every society, how the act of ending
one’s life is interpreted and understood is highly variable. Staples and Widger (2012)
argue that suicide should be understood as a “kind of sociality… through which people
create meaning in their own lives” (183). At the risk of reifying problematic binaries of
individual vs. society, one can make the argument that suicide is a useful tool for
considering not only how people make meaning in their own lives through a sociality
facilitated by suicide, but how this sociality is experienced and leads to meaning-making
on a collective level. In societies where the concept of the person is inherently diffused
through the extension of the self into space, as is the case among Yucatec Maya people,
the collective experience of suicide becomes particularly relevant.
I was originally drawn to study suicide in Yucatán when I found out that
Yucatán’s suicide rate more than doubles the Mexican national average. During
preliminary fieldwork, I repeatedly came across newspapers featuring pictures of suicides
on their front covers with flashy headlines such “He followed the funereal steps of Ixtab”
(González 2008) or “He worshipped Ixtab” (2008). As a Mayanist, I was drawn to the
enigma of suicide and the repeated newspaper mentions of Ix Tab (cf .Reyes-Foster 2012,
2013), the “goddess of the gallows” described in Diego de Landa’s colonial manuscript
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Relación de las Cosas de Yucatán (de Landa 1978). Preliminary research showed some
compelling evidence of high suicide rates and quite a bit of public interest in the topic
(manifested through the many newspaper reports and depictions of suicide as well as a
weekly column and radio show devoted to the topic of prevention). Moreover, suicide
attempts seemed common throughout the peninsula. Regardless of who I spoke to or
where I traveled, in every village, town, and city I encountered people whose lives had
been affected by suicide and suicide attempts. These early experiential encounters
encouraged me to address the topic in a systematic manner.
In 2008, just as it had in previous years (and since), the suicide rate in Yucatán
more than doubled the national average of Mexico (INEGI 2008). As a cultural
anthropologist, by original research question focused on the possibilities of a social
construction of suicide. As I began to spend more and more time interviewing people
who had attempted suicide, noticed that the discourse people used to talk about suicide
was heavily laden with religious and spiritual references, and that these references were
embedded within their discourses about body and mind.
Many of these spiritual references and the discourses they index can be traced
back to the Spanish Colonial Period. According to Diego de Landa (de Landa 1978), the
people inhabiting the Yucatán Peninsula at the time of the conquest
said and held it as absolutely certain that those who hanged themselves
went to this heaven of theirs; and on this account, there were many
persons who on slight occasions of sorrows, troubles, or sicknesses,
hanged themselves in order to escape these things and to go and rest in
their heaven, where they said that the goddess of the gallows, whom they
called Ix Tab, came to fetch them (Tozzer 1941:132).
Alfred Tozzer (1941) believes that Landa probably wrote his Relación in Spain
around 1566. Nearly 50 years later, in 1613, Pedro Sánchez de Aguilar would bemoan the
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Indian propensity for suicide. In his Informe Contra Idolores Cultores (Sánchez de
Aguilar 1996), written to demonstrate the failures of the “spiritual conquest” of Yucatán,
Sánchez de Aguilar recommends the creation of a new position, a fiscal, within
individual Yucatecan churches. Among the fiscal’s duties would be the administration of
bien morir, the good death:
This fiscal, knowing how to read, and write, should help the ill to die well
[bien morir], giving form to the ritual… and talking to him to encourage
him and revive his faith and hope. Because, without this consolation and
comfort, [the dying] despair, and are strongly tempted by the Devil to
hang themselves [my emphasis].
This colonial text is strong evidence of a prevalence of suicide in the colonial period. It
also first introduces the idea of demonic intervention in suicide. However, my own
ethnographic research –and that of other ethnographers of suicide in the Maya area (cf
Baquedano 2009, Hernandez Ruiz 2010, Imberton 2012)—did not uncover any
contemporary mentions of Ix Tab or of a goddess of suicide in Maya communities.
Overwhelmingly, motifs in suicide discourse in Maya communities in Yucatan center on
discourses and theories of demonic intervention as the underlying cause of suicide.3
Self, Community, and Space
In Xulab, Lidia, the community health technician, framed her experiences following
the suicides of Ana and Maria as demonic attacks. “Evil” or el Mal, as it is commonly
called in Spanish, is another name for the Devil. The role of the demonic in suicides in
Yucatan repeatedly appeared in my work and has also been documented by Baquedano-
Lopez (2009) and Hernandez Ruiz (2010). Gracia Imberton’s (2012) work among the
Chol Maya of Chiapas also uncovered demonic intervention as a common cause of
suicide. Many previous studies of the demonic in Latin America treat the Devil as a
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character of folk narrative or as a metaphor for class and gender oppression (Edelman
1994; Nash 1997; Sanabria 2007; Taussig 1980). In Yucatán, however, there is nothing
metaphorical, allegorical, or figurative about the demonic and its role in suicide.
In suicide discourse, the suicida is a victim of demonic intervention. Interlocutors
will often go so far as to state that the Devil physically places the rope around the
suicida’s neck. However, these same interlocutors will also say that suicide is in fact an
agentive act and the suicida does have to face the consequences of the sin of suicide. In
the same conversation I had with Lidia about suicide as a demonic attack on an innocent,
Lidia’s discourse reflected a view of suicide that was simultaneously agentive and non-
agentive:
My father was very upset that they buried [Ana] with a normal Catholic
ceremony. He said her family should have stuck wooden horns in her ears
to drive out the evil, and verbally harassed the corpse, telling her what she
did was a bad thing, telling her to leave, to get out of here… then when
[María] died, some elders said the same thing, that they needed hammer
wooden horns in her head, and circle her head with 12 needles to keep her
from taking another… When Ana died, I told my sister, you know, this
girl, her family didn’t go to church, she didn’t have a religion, maybe, to
save her own soul, she’ll take someone who is close to God. When my
sister came by to visit the other day I reminded her. I told her, “see?
Remember I told you she might take someone close to God?”
In this excerpt, Lidia describes the ideal mortuary treatment for a suicide that is
quite different from Catholic burial rituals, which do not differentiate between suicidal
vs. non-suicidal deaths. The corpse is disfigured and verbally abused as it is taken for
burial. In this sense, the corpse, the material remains of the person, is punished.
Furthermore, Lidia notes that she believed, even before Maria’s death, that Ana would
“take one close to God to save her own soul.” This in and of itself is a fascinating
statement: if Ana was a victim, why would she be able to “save her soul” after death?
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Why does her soul need saving if she in fact was forced by the Devil to commit suicide?
If her Maria is an innocent victim, why is she condemned to hell?
Lidia also spoke about the consequences of suicide for the deceased, stating that
“[the soul of a suicide] does not enjoy the gates of Heaven, they go to Hell, because they
belong to the Devil.” However, when I asked her whether those who commit suicide are
called back during Hanal Pixan, the annual return of the dead to the world of the living
that coincides with the Mexican Day of the Dead, she responded in the affirmative. “We
hold Mass and rosary prayers for them, and welcome them back for the feast of the dead,
but, as the say, doing these things just lowers down the flames of Hell for a little while.
When the prayers are over the heat turns back on.” During our conversation, Lidia
repeatedly stated that “what they [Ana and Maria] did was bad,” while at the same time
emphasizing that each was a victim of demonic intervention. This anecdote illustrates the
contradiction and ambivalence in discourse about suicide in Yucatán regarding the causes
and consequences of voluntary death.
Lack of consensus and balance in community life is locally understood as a
source of illness. People in Xulab interpreted Ana and María’s suicides as physical
manifestations of a disease afflicting the entire town. Figuratively speaking, a deep social
illness –rooted in ongoing conflicts between various factions inside the community—had
“opened” the village and made it vulnerable to the unwelcome demonic entrance. “There
was a time,” Lidia explains, “when we had a fight at every community meeting. The
women couldn’t even set eyes on one another… sometimes, the meeting would have to
get broken up because of the fighting… our village didn’t use to be like this. People still
aren’t speaking to one another.”
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Christine Kray’s (2005) work on tranquility in Dzitnup, a town in the same
region as Xulab, shows a similar expressed desire for consensus. Kray alludes to the kind
of disagreements created by religious and political differences, noting that in Dzitnup
“tranquility indicates the ideal state of affairs, one in which everyone is in agreement,
everything of value is evenly distributed, and respect and respectability characterize
human relationships” (340). When the balance is broken, the community becomes
vulnerable to illness, broadly defined as both spiritual and physical. People in Dzitnup
take pride in the tranquility of their town. In Xulab, people despaired from the lack of it.
The responsibility of Ana and María’s suicide was carried by everyone in the community:
the Devil may have been the proximal culprit in the girls’ deaths, but the community was
to a great extent responsible for allowing the Devil in when the social equilibrium was
lost.
The concept of person in Yucatán is characterized by a certain fluidity of
boundaries. This fluidity has profound historical roots, not only in pre-Colombian Maya
culture (Gillespie 2001; McAnany 1995) but in the mystical Catholicism practiced by
those in charge of Yucatán’s so-called “Spiritual Conquest” (Lizana 1995). Javier
Hirose’s (2008) work on the body in the Chenes region of Campeche focuses on
relationship between body and space, emphasizing the possibility of occupying several
physical spaces at once, and linking a necessary equilibrium in the relationship between
person and space to health:
“According to the ideas of a traditional doctor from the state of Campeche
regarding the body and its relationship with the universe, the spaces
occupied by the human being in the cosmos –the home, the solar, the
milpa, the town, and the world—constitute extensions of the body, while
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the spatial-temporal location of the human being in relationship with these
spaces determines the condition of illness or health” (1).
Timoteo Rodríguez and Juan Castillo Cocom (2010) document a similar concept of
person and space which they term iknal. Echoing Hirose’s discussion space and time,
Rodríguez and Castillo Cocom state, “Our presence is forged within a proximity to our
memories. The bond of one’s sensibility to selfhood and to those memories gauges a ratio
of presence –a moving ratio of presence coalescing through the recent past and near
future. This bond is a spatial presence understood as one’s iknal” (9). This bond gives
meaning to place, and turns physical space into extensions of the self.
In his doctoral dissertation, Hirose carefully and exhaustively catalogues the
myriad of Yucatec names and terms for various body parts including internal organs,
bones, and external characteristics as well as biological states such as pregnancy. Hirose
notes that the Maya person is a single entity that expresses five elements (earth, water,
fire, wind, and light) that are projected in a sort of corporeal aura. The actual body is but
a “wrapping” (kukut) for the spirit, made up of the pixan (soul) and the ool (breath of
life). The pixan inhabits the entire body, the ool is primarily located in the blood
(Redfield and Villa Rojas 1933). Subsequently, he explains the ontological
understanding of the body as yaan (right side, male, translates to “there is”) and yuum
(left side, female, translates to “lord”) together forming a single concept: yaan yuum,
“there is the Lord”.
Hirose argues that the natural equilibrium forming the concept yaan yuum is in
fact a state of health, in other words, that not only can the cure of illness be found in a
Creator, but that the Creator itself can be found within the human body in proper
equilibrium. This sense of equilibrium extends beyond the individual body to the body
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social because the self itself extends into physical space. If the key to bodily and spiritual
health lies in a harmonic relationship between these physical extensions of the self and
the individual “wrapping” represented by the human body, as described by Hirose, it
follows, then, and every person can extend into every other person that occupies the same
place.
Thus, the self is not merely one part of the community; rather, the entire community
is a system of selves connected in space and time. A lack of consensus, or “tranquility,”
to borrow Kray’s term, is dangerous to the physical and spiritual health of everyone in the
village. Clearly, this is not to say that in every village and town there are no breaks in
tranquility, consensus, or harmony. In fact, squabbles over political party, religion, and
other scandals are commonplace everywhere in the Yucatán. These, however, are seen as
extremely negative events. Community harmony is thus paramount: the health of an
entire community depends on this equilibrium because everyone is linked in a
metaphorical and physical way. More importantly, the presence of this equilibrium
implies the presence of the divine, the antithesis of evil.
Why take the demonic “seriously”? In considering the interplay of Western mental
health services and locally generated worldviews, I kept running into a single question:
Given what I knew about Maya understandings of personhood, spirit, and space, why did
Maya people appear to readily embrace the biomedical model of psychiatry to explain
suicide? I soon realized that pre-existing ideas about suicide, its etiology and its
prevention continued to thrive –including the ever-central role of the demonic—and
biomedicine was simply adopted into an existing, locally generated discourse of health.
This conclusion brought about yet another question: what was it about Yucatecan culture
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that allowed two seemingly conflicting and irreconcilable worldviews to coexist in such a
harmonious way?
Hospital Psiquiátrico Yucatán
Hospital Psiquiátrico Yucatán (HPY) is located almost 100 miles and a world
away from Xulab. It is an in-patient psychiatric facility that accommodates 160 beds. Its
operation follows a biomedical approach: patients are treated with a combination of
psychiatric drugs and individual and group counseling. Although Mexican psychology
has early roots in European psychology, psychiatry, and psychoanalysis, as of the mid-
twentieth century American psychiatric and psychological models have dominated
Mexican psychological and psychiatric practice (Galindo 2004). The Health and
Wellness Department is charged with operating HPY, the only psychiatric facility in the
peninsula. Patients who enter the hospital are funneled to it from every other health care
system in Yucatan and other nearby states such as Campeche, Quintana Roo, Chiapas,
and Tabasco. Usually, patients are only referred to HPY if they are showing symptoms so
severe that 1) they are posing a danger to themselves or others, 2) their families are
unable to care for them and they are unable to care for themselves, 3) they have received
outpatient psychiatric treatment and have not responded, or 4) they have had repeated and
increasingly lethal suicide attempts. Patients who arrive at HPY have usually been
undergoing some sort of psychological or psychiatric treatment for some time.
Within the facility, Programa Integral de Atención al Suicidio (PIAS), a suicide
prevention program, has taken a holistic approach to treatment. Its founder, psychiatrist
Gaspar Baquedano Lopez, holds a Master’s degree in anthropology. Having studied
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suicide for over 25 years, he advocates for a prevention approach that focuses on
improving patients’ quality of life and involving family, friends, and neighbors in the
effort. “We never tell people not to kill themselves,” he explains, “we ask them why they
want to die. Most of them have never been asked that question.”
PIAS was reinitiated in the fall of 2007 after seven years on hiatus by Dr.
Gaspar Baquedano Lopez.4 As its website states,
[PIAS’ stated goal] is to offer though an interdisciplinary approach the
institutional resources and strategies in order to detect and psychiatrically,
psychologically, and socially treat people with suicidal risk and their families. In
this way we seek a rapid biological, psychological, and social recovery of the
user.
Dr. Baquedano’s vision for PIAS is a program that seeks holistic psychiatric
treatment for people who had attempted suicide and their families. Typically, a
patient is admitted due to a suicide attempt at the psychiatric hospital when the
attempt is particularly lethal or is the latest in a series of multiple attempts.
Patients are referred from public hospitals in the region once their injuries have
been stabilized and remain at HPY on average about three weeks (Yucatán),
although in my time there I saw several patients stay for longer than a month.
During their stay, patients are introduced to the PIAS program, where they attend
small, in-patient group therapy sessions twice a week and a weekly group
meeting. Once the patients are released, they are invited to continue attending the
weekly meeting with their families. In six months of ethnographic research, most
of the patients I worked with who entered the hospital for in-patient treatment
returned to at least a few sessions while others became regular attendees.
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Patients also continue using the psychiatric hospital’s other services,
usually seeing a non-PIAS affiliated psychiatrist as well as attending weekly
PIAS meetings. Because the hospital is the only psychiatric hospital in the region,
it serves people of all walks of life, though PIAS patients are predominantly
indigenous, poor, and female. Ironically, although a majority of PIAS participants
are women, the group is dominated by the male members, who tend to speak and
direct meetings more than the female members. This ease of leadership on the part
of men can be related to expectations of male dominance of public space as well
as male group members' familiarity and participation in 12-step recovery groups,
which function in Mexico as spaces for the creation and reiteration of masculinity
(Brandes 2002).
Every Thursday morning at HPY, a group of people gathers at the Sigmund
Freud room for a group therapy session that resembles a twelve-step meeting more than
any Western psychotherapeutic model. Anywhere between thirty to sixty men and
women fill the room and for the next hour and half the patients, who are called
“usuarios” or “users” in hospital lingo, share their experiences with pain, despair and
hopelessness. Usually one will stand and show the rest of the group the scars on her
wrists or the deep, red indentation created by a rope during a hanging attempt and relate
her story. These sessions offered tremendous insight into the ways in which survivors of
suicide attempts make sense of their lives, and also about how the relationships between
users and hospital staff and volunteers is manifested in the group. Six months of
ethnographic research at HPY with the PIAS suicide prevention group revealed much
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about the ways in which this program functions to both transform and reiterate patients'
relationships with the medical establishment, each other, and their own bodies.
The trope of suicide as a symptom of disease effectively making the user attempt
suicide represents the medicalization of the demonic in suicide discourse. Instead of it
being the devil that ties the knot around a suicida’s neck, the enfermedad, the illness,
takes on this role. However, the association of the demonic to suicide is by no means
replaced by a physiological understanding of mental illness rooted in brain chemistry. To
quote Gaspar Baquedano, “Mental illness and suicide are considered as having an evil
origin. It is a manifestation of the devil under the disguise of a medical disorder, even if it
is treated with medicine, in the end it is connected to the supernatural world” (Baquedano
2009:79). The Devil, then remains the underlying cause of the suicide, while the mental
illness becomes the means by which the Devil achieves his objective.
This viewpoint was discernible at every PIAS meeting I attended, where phrases
such as “no le demos derecho al Diablo, “let us not give the Devil the right”, que no nos
gane la mente, “let us not let our mind ‘win’”, con la ayuda de Dios, “with the help of
God” were frequently used. Patients who had survived suicide attempts never explained
their experiences as rationally made decisions. Moreover, the vast majority of cases
described the events leading up to their suicide attempts as otherworldly experiences.
Patients described visions, dreams, and demonic presences and voices in experiences
immediately preceding their attempt. In patient discourse at HPY, the idea of “fighting
the devil” frequently recurred.
In my weekly observations of the PIAS group therapy sessions, I found that PIAS
meetings often echoed a long-established and widely successful recovery model: the 12
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step Alcoholics Anonymous (AA) model. The existence of 12-step recovery programs
like Alcoholics Anonymous has created a beneficial environment for the flourishing of
the PIAS program. First, the cornerstone of Alcoholics Anonymous is the iteration of
alcoholism as a physical disease. However, the treatment of this disease, the Twelve
Steps themselves, is spiritual (Anonymous 1981). As such, the Twelve Steps of
Alcoholics Anonymous posit a spiritual cure to a physical affliction, blurring the
boundaries of body and spirit in a way that is not only compatible with local
understandings of the person, but sets the stage for a similar view of other forms of
enfermedad. The blending of spiritual and organic elements in the etiology of alcoholism
speaks to a deeper level of cosmological coherency that allows for the adaptation of
biomedicine into local etiologies of health.
Biomedicine was often considered an effective tool in battling the demonic
entities that cause suicide. Although PIAS does not actively engage with the demonic
narratives shared by the vast majority of its members, the discourse of agency is absorbed
into the demonic narratives. While patients still attribute their suicidal ideation to
demonic intervention, they articulate a newfound ability to resist these attacks on their
spiritual health. Like Lidia, the community health technician from Xulab, PIAS patients
at HPY can fight the Devil with medicine and psychotherapy as well as by relying on
belonging to a strong, healthy community and renewed spirituality.
Conclusion
In his chapter of the Oxford Textbook of Suicidology and Suicide Prevention
(2009), Gaspar Baquedano-López frequently uses two words in his analysis of suicide in
Yucatán: religion and ambivalence. In my own research, these two words became a
19
frequent presence in my field notes and interview analyses. For a Yucatecan to attribute
suicide to the devil and condemn the suicida in a single utterance was as common as it
was for a psychiatric patient to discuss the efficacy of psychotherapy and medication in
staving off the devil’s advances. Unlike Binswanger’s Ellen West (Binswanger 1958),
nearly every person I spoke to who had attempted suicide expressed a desire for life.
Every person I spoke to used a similar narrative of spiritual struggle in describing their
suicide attempt. Individual agency was not as important as finding the right equilibrium
within a self conceived of as body, spirit, and space. Biomedicine, with a language that
emphasizes finding equilibrium in brain chemistry, is one way of achieving it that can be
combined with others.
Within classic psychiatric biomedical discourse, this point would be irrelevant. In
the words of Dr. Baquedano-López, who has been pioneering efforts to incorporate
anthropological and social scientific perspectives to the treatment of psychiatric patients
in Yucatan, to most psychiatrists and psychologists, the culturally specific discourses of
patients ultimately boil down to puras pendejadas, utter nonsense. As Charlotte Blease
has argued in her analysis against the Culturally Bound Syndromes (CBS) category in the
DSM-IV, “folk theories” are simply nonscientific explanations for existing, scientifically
proven illness categories (Blease 2010). The assumption of the DSM-IV is that all
human beings essentially think the same way and experience the same mental illnesses
regardless of where they are. Through biomedical discourse, mental illness –and suicide
as a result of mental illness—is reduced to a series of organic occurrences in the brain.
How these organic occurrences may manifest differently cross-culturally has had the
attention of anthropologists as well as psychologists engaged in the well-established field
20
of cross-cultural psychology, but as of 2008 had not translated into organized local
applications of “culturally competent” psychology in Yucatecan clinical practice. That
said, biomedicine’s success in Yucatan is perhaps not indicative of a transformation in
the subject population, but rather indexes the ways in which this worldview has been
subsumed into local etiologies of health.
Lidia, Xulab’s community health technician, never had to visit HPY. She
never attempted suicide. However, when she began to experience what she believed was
a demonic assault on her sanity, she did not hesitate to seek help from a mental health
professional. As a community health technician, she understood local health resources
and used them. The same logic that facilitates PIAS’ success at HPY informed her use of
local psychological and psychiatric resources to treat a spiritual ailment. In the same way
that prayer protected her spirit, therapy protected her mind, and medication tended to her
body. Like prayer, therapy and medication were simply part of her religious arsenal for
fighting the Devil. In many ways, this logic reveals what an early reviewer of this piece
called a “deeper level of cosmological coherency” that was visible in the in the words,
actions, and interactions of the research subjects profiled in this article, a coherency that
can be found by looking beyond the internal contradictions visible at first glance. As I
stated at the outset of this article, the contradictory nature of the Yucatecan attitude
toward suicide is a sympathetic template upon which biomedical discourse can map
itself. But, like a transparent film placed over a map, the elaborate geography beneath it
remains.
21
Endnotes
1. This research was supported by a Fulbright-Hays Doctoral Dissertation Research
Abroad grant and was approved by the University of California Berkeley Office for the
Protection of Human Subjects Institutional Review Board (OPHS-IRB).
2. All names of people, living and dead (with the exception of Dr. Gaspar Baquedano,
who is a recognized scholar in the field) have been changed to protect their identities. The
name and geographical location of Xulab has been changed. However, it would have
been impractical to attempt to change or disguise the name of Merida, the capital of the
state of Yucatán, or of the field site, Hospital Psiquiátrico Yucatán.
3. Baquedano (2009) presents a compelling argument whereby a pre-existing ethos
possibly accepting of suicide was transformed but not eradicated through the colonial
process.
4. The existence of many social programs at Yucatecan public hospitals is highly
dependent on political affiliation and alliance. PIAS went on a seven-year hiatus because
of a change in the state government political affiliation.
5. Moreover, “Western” as an ontological category bears further scrutiny: the term is
laden with a multiplicity of meanings. Due to constraints of space, an in-depth discussion
of the problems of “Western” and its application to long-term postcolonial societies like
those in Latin America is not possible here.
22
6. The complexity of identity in Yucatan has been addressed elsewhere by others
(Castañeda 1996; 2004; Castañeda and Fallaw 2004; Castillo Cocom 2000; 2005; Castillo
Cocom and Ríos Luviano 2012) and myself (2012).
References Cited
2008 Ilman rindió culto a Ixtab. In De Peso, Vol. Alerta Yucatán. Merida.
American Psychiatric, Association
2000 Diagnosis and Statistical Manual of Mental Disorder (Text Revision). Volume IV:
American Psychiatric Association.
Anonymous, Alcoholics
1981 Twelve Steps and Twelve Traditions. New York: Alcoholics Anonymous World
Services, Inc.
Asad, T.
1993 Genealogies of Religion: Discipline and Reasons of Power in Christianity and
Islam. Baltimore: The Johns Hopkins University Press.
Baquedano, Gaspar
2009 Maya religion and traditions: Influencing suicide prevention in contemporary
Mexico. In Oxford Textbook of Suicidology and Suicide Prevention: A Global
Perspective. D. Wasserman and C. Wasserman, eds. Pp. 77-84. New York:
Oxford University Press.
Bell, Catherine
1992 Ritual Theory, Ritual Practice. New York: Oxford.
Binswanger, Ludwig
1958 The Case of Ellen West: An Anthropological-Clinical Study. In Existence: A New
Dimension in Psychiatry and Psychology. R. May, E. Angel, and H.F.
Ellenberger, eds. New York: Basic Books.
23
Blease, Charlotte
2010 Scientific Progress and the Prospects for Culture-Bound Syndromes. Studies in
History and Philosophy of Biological and Biomedical Sciences 41(Journal
Article):333-339.
Bohannan, Paul
1960 African Homicide and Suicide. Princeton: Princeton University Press.
Boremanse, Didier
1993 The faith of real people: The Lacandon of the Chiapas rain forest. In G. Gossen
(Ed.), South and Meso-American native spirituality: From the cult of the
feathered serpent to the theology of liberaton (pp. 324-351). New York:
Crossroads Publishing.
Brandes, Stanley S.
2002 Staying Sober in Mexico City. Austin: University of Texas Press.
Castañeda, Quetzil
1996 In the Museum of Maya Culture: Touring Chichén Itzá. Minneapolis: University
of Minnesota Press.
2004 "We Are Not Indigenous!" An Introduction to the Maya Identity of Yucatan. The
Journal of Latin American Anthropology 9(1):36-63.
Castañeda, Quetzil, and Ben W. Fallaw
2004 The Maya Identity of Yucatan, 1500-1935: Re-Thinking Ethnicity, History, and
Anthropology. Journal of Latin American Anthropology 9(1).
Castillo Cocom, Juan
2000 Vulnerable Identities: Maya Yucatec Identities in a Postmodern World, Florida
International University.
2005 'It Was Simply Their Word': Yucatec Maya PRInces in YucaPAN and the Politics
of Respect. Critique of Anthropology 25(2):131-155.
Castillo Cocom, Juan, and Saúl Ríos Luviano
2012 Hot and Cold Politics of Indigenous Identity: Legal Indians, Cannibals, Words,
More Words, More Food. Anthropological Quarterly 85(1): 229-256.
24
Chao, Emily
1999 The Maoist Shaman and the Madman: Ritual Bricolage, Failed Ritual, and Failed
Ritual Theory. Cultural Anthropology, 14(4), 505-534.
Csordas, Thomas J.
1994 Introduction: The body as representation and being-in-the-world. In Embodiment
and Experience. T.J. Csordas, ed. Cambridge: Cambridge University Press.
1997 Language, Charisma, and Creativity: The Ritual Life of a Religious Movement.
Berkeley, Los Angeles, London: University of California Press.
de Landa, Diego
1978 Yucatan Before and After the Conquest. New York: Dover Publications.
Durkheim, Emile
1951[1897] Suicide: A Study in Sociology. London: Routledge.
Edelman, Marc
1994 Landlords and the Devil: Class, Ethnic, and Gender Dimensions of Central
American Peasant Narratives. Cultural Anthropology 9(1):58-93.
Foucault, Michel
1978 The History of Sexuality: An Introduction Vol. 1.
Galindo, Edgar
2004 Análisis de Desarrollo de la Psicología en México hasta 1990. Con bibliografía in
extenso. Psicología para América Latina 2.
Giddens, Anthony
1964 Suicide, Attempted Suicide, and the Suicidal Threat. Man 64:115-116.
Gillespie, Susan D.
2001 Personhood, Agency, and Mortuary Ritual: A Case Study from the Ancient Maya.
Journal of Anthropological Archaeology 20(Journal Article):73-112.
González, Yecenia
2008 Suicidas "agarraron valor". In Por Esto! Quintana Roo. Pp. 3, Vol. Estado.
Cancún, Quintana Roo: Compañía Editora Nuestra América, S.A. de C.V.
25
Hanks, W. F.
1984 Sanctification, Structure, and Experience in a Yucatec Ritual Event. Journal of
American Folklore, 97(384), 131-166.
Hirose, Javier
2008 El ser humano como eje cósmico: las concepciones del cuerpo y la persona entre
los mayas de la region de los chenes, Campeche, Universidad Nacional Autónoma
de México.
Huntington, R., & Metcalf, P.
1979 Celebrations of Death: the Anthropology of Funerary Ritual. London:
Cambridge University Press.
Imberton, Gracia
2012 Chol Understandings of Suicide and Human Agency. Culture, Medicine, and
Psychiatry 36(2):245-263.
INEGI
2008 Estadística de suicidios de los Estados Unidos Mexicanos 2008. Mexico, D.F.:
Instituto Nacional de Geografía, Estadística e Informática.
Kray, Christine A.
2005 The Sense of Tranquility: Bodily Practice and Ethnic Classes in Yucat√°n.
Ethnology 44(4):pp. 337-355.
Lizana, Bernardo de
1995 Devocionario de nuestra Señora de Izamal y conquista espiritual de Yucatán.
Volume 5. México, D.F.: Universidad Nacional Autónoma de México.
Mauss, Marcel
1973 Techniques of the Body. Economy and Society, 2(1), 70-88.
McAnany, Patricia
26
1995 Living with the Ancestors: Kinship and Kingship in Ancient Maya Society.
Austin: University of Texas Press.
Nash, June
1997 Gendered Deities and the Survival of Culture. Journal of the History of Religion
36(4):333-356.
Redfield, Robert, and Alfonso Villa Rojas
1933 Chan Kom: A Maya Village. Chicago: The University of Chicago Press.
Reyes-Foster, Beatriz
2012 Grieving for Mestizaje: Alternative Approaches to Maya Identity in Yucatan,
Mexico. Identities: Global Studies in Culture and Power 19(6):657-672.
2013 He Followed the Funereal Steps of Ixtab: The Pleasurable Aesthetics of Suicide in
Newspaper Journalism in Yucatán, Mexico. The Journal of Latin American and
Caribbean Anthropology 18(2):251-273.
Sanabria, Harry
2007 The Anthropology of Latin America and the Caribbean. Boston: Pearson.
Sánchez de Aguilar, Pedro
1996 Informe Contra Idolorum Cultores del Obispado de Yucatán. Escrito en 1613 y
publicado en 1639. Volume 5. Valladolid: Instituto Cultural Valladolid, A.C.
Staples, James
2003 Disguise, revelation and copyright: Disassembling the South Indian leper. Journal
of the Royal Anthropological Institute (N.S.) 9:295-315.
Staples, James and Tom Widger
2012 Situating Suicide as an Anthropological Problem: Ethnographic Approaches to
Understanding Self-Harm and Self-Inflicted Death. Culture, Medicine, and
Psychiatry 36(2):183-203.
Taussig, Michael
1980 The Devil and Commodity Fetishism in South America. Chapel Hill: University
of North Carolina Press.
27
Tozzer, Alfred M.
1941 Landa's Relación de las Cosas de Yucatán. Volume 18. Cambridge: Harvard
Universtiy Press.
WHO
2011 Suicide Rates per 100,000 by Country, Year, and Sex (Table), Vol. 2011: World
Health Organization.
Yucatán, Hospital Psiquiátrico
Programa Integral de Atención al Suicidio (P.I.A.S.), Vol. 2012. Merida, Mexico.